NPIMap

Organization Active NPI

Central Illinois Friends of Pwa, Inc.

  • Community Health Clinic/Center
  • Galesburg, IL
National Provider Identifier
1932058963
Registry record updated Jul 22, 2026
On this page

Key facts

NPPES NPI Registry
Primary specialty
Community Health Clinic/CenterTaxonomy code 261QC1500X
Legal business name
CENTRAL ILLINOIS FRIENDS OF PWA, INC.
Practice address
311 E Main St Ste 409
Galesburg, IL 61401-4867
Phone
(309) 431-5880
NPI assigned
Jan 23, 2026
Last updated
Jul 22, 2026By the provider in NPPES
Organization subpart
No

NPPES NPI Registry

Updated by the provider on Jul 22, 2026

Registry information is reported by the provider to CMS and is not verified. About this source

Authorized official

Name
Deric Kimler
Title
Executive Director
Phone
(309) 431-5880

Specialties & licenses 3

Specialty (taxonomy)CodeLicenseStatePrimary
Public Health or Welfare Agency 251K00000X
Community Health Clinic/Center 261QC1500X Primary
Non-Surgical Family Planning Clinic/Center 261QF0050X

Addresses

Primary practice location

311 E Main St Ste 409
Galesburg, IL 61401-4867

Mailing address

PO Box 5022
Peoria, IL 61601-5022
Phone (309) 431-5880

National Provider Directory

National Provider Directory
Tax ID family
Central Illinois Friends of Pwa Inc5 organizations share this tax ID, including this one

Other organizations with this tax ID 4

Organizations that report the same tax identification number in the National Provider Directory.

Locations

311 E Main St
Ste 409
Galesburg, IL 61401
Phone (309) 343-6162

NPI Registry JSON

The complete NPPES record for this NPI in the NPI Registry API format.

{
    "created_epoch": "1769126400000",
    "enumeration_type": "NPI-2",
    "last_updated_epoch": "1784678400000",
    "number": "1932058963",
    "addresses": [
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "MAILING",
            "address_type": "DOM",
            "address_1": "PO BOX 5022",
            "city": "PEORIA",
            "state": "IL",
            "postal_code": "616015022",
            "telephone_number": "309-431-5880"
        },
        {
            "country_code": "US",
            "country_name": "United States",
            "address_purpose": "LOCATION",
            "address_type": "DOM",
            "address_1": "311 E MAIN ST STE 409",
            "city": "GALESBURG",
            "state": "IL",
            "postal_code": "614014867",
            "telephone_number": "309-431-5880"
        }
    ],
    "practiceLocations": [],
    "basic": {
        "organization_name": "CENTRAL ILLINOIS FRIENDS OF PWA, INC.",
        "organizational_subpart": "NO",
        "enumeration_date": "2026-01-23",
        "last_updated": "2026-07-22",
        "certification_date": "2026-07-22",
        "status": "A",
        "authorized_official_last_name": "KIMLER",
        "authorized_official_first_name": "DERIC",
        "authorized_official_title_or_position": "EXECUTIVE DIRECTOR",
        "authorized_official_telephone_number": "309-431-5880"
    },
    "taxonomies": [
        {
            "code": "251K00000X",
            "taxonomy_group": "",
            "desc": "Public Health or Welfare",
            "state": null,
            "license": null,
            "primary": false
        },
        {
            "code": "261QC1500X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Community Health",
            "state": null,
            "license": null,
            "primary": true
        },
        {
            "code": "261QF0050X",
            "taxonomy_group": "",
            "desc": "Clinic/Center, Family Planning, Non-Surgical",
            "state": null,
            "license": null,
            "primary": false
        }
    ],
    "identifiers": [],
    "endpoints": [],
    "other_names": []
}

Other providers in Galesburg, IL

Sources for this page

  • NPPES NPI Registry (CMS): identity, addresses, specialties, licenses, identifiers and endpoints. Last updated by the provider on Jul 22, 2026; self-reported and not verified by CMS. Specialty names from the NUCC taxonomy.
  • National Provider Directory (CMS): practice roles, locations, licenses, networks and endpoints.

Verify at the official NPI Registry.